Provider Demographics
NPI:1245212414
Name:INTEGRATED SPINE CARE, S.C.
Entity Type:Organization
Organization Name:INTEGRATED SPINE CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-988-5100
Mailing Address - Street 1:601 N 99TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4339
Mailing Address - Country:US
Mailing Address - Phone:414-988-5100
Mailing Address - Fax:414-988-5102
Practice Address - Street 1:601 N 99TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4339
Practice Address - Country:US
Practice Address - Phone:414-988-5100
Practice Address - Fax:414-988-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI574150-9207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02885Medicare ID - Type Unspecified